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Background   Plasmodium falciparum  and  Plasmodium vivax  are endemic in Vanuatu and the Solomon Islands. While both countries have introduced artemether-lumefantrine (AL) as first-line therapy for both  P. falciparum  and  P. vivax  since 2008, chloroquine and sulphadoxine-pyrimethamine (SP) were used as first-line therapy for many years prior to the introduction of AL. Limited data are available on the extent of SP resistance at the time of policy change.    Methods  Blood spots were obtained from epidemiological surveys conducted on Tanna Island, Tafea Province, Vanuatu and Temotu Province, Solomon Islands in 2008. Additional samples from Malaita Province, Solomon Islands were collected as part of an AL therapeutic efficacy study conducted in 2008.  Plasmodium vivax  and  P. falciparum dhfr  and  dhps  genes were sequenced to detect nucleotide polymorphisms.    Results  All  P. falciparum  samples analysed (n =114) possessed a double mutant  pfdhfr  allele (C59 R /S108 N)  .  Additionally, mutation A437 G  in  pfhdps  was detected in a small number of samples 2/13, 1/17 and 3/26 from Tanna Island, Vanuatu and Temotu and Malaita Provinces Solomon Islands respectively. Mutations were also common in  pvdhfr  from Tanna Island, Vanuatu, where 33/51 parasites carried the double amino acid substitution S58 R /S117 N , while in Temotu and Malaita Provinces, Solomon Islands 32/40 and 39/46 isolates carried the quadruple amino acid substitution F57 L /S58 R /T61 M /S117 T  in DHFR respectively. No mutations in  pvdhps  (n =108) were detected in these three island groups.    Conclusion  Prior to the introduction of AL, there was a moderate level of SP resistance in the  P. falciparum  population that may cause SP treatment failure in young children. Of the  P. vivax  isolates, a majority of Solomon Islands isolates carried quadruple mutant  pvdhfr  alleles while a majority of Vanuatu isolates carried double mutant  pvdhfr  alleles. This suggests a higher level of SP resistance in the  P. vivax  population in Solomon Islands compared to the sympatric  P. falciparum  population and there is a higher level of SP resistance in  P. vivax  parasites from Solomon Islands than Vanuatu. This study demonstrates that the change of treatment policy in these countries from SP to ACT was timely. The information also provides a baseline for future monitoring.

malaria journal

Genetic mutations in Plasmodium falciparum and Plasmodium vivax dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) in Vanuatu and Solomon Islands prior to the introduction of artemisinin combination therapy